CPCS CPCS - Certified Provider Credentialing Specialist Accreditation Standards and Compliance Questions and Answers 2 — Questions and Answers
Question 1: Which accreditation organization requires a credentialing committee to include at least one physician member when making privileging recommendations?
- The Joint Commission (TJC) (Correct answer)
- NCQA
- URAC
- DNV GL Healthcare
Correct answer: The Joint Commission (TJC)
The Joint Commission requires that the medical staff credentialing and privileging process involve physician participation, including physician representation on credentialing committees.
The Joint Commission's medical staff standards require that physicians be involved in the credentialing and privileging process. This ensures peer review by qualified practitioners. TJC MS.06.01.03 outlines that the organized medical staff is responsible for recommending to the governing body practitioners who are eligible for appointment to the medical staff.
Question 2: URAC's credentialing accreditation standard requires initial credentialing to be completed within how many days of receiving a completed application?
- 60 days
- 90 days
- 120 days (Correct answer)
- 180 days
Correct answer: 120 days
URAC standards generally require that the credentialing process be completed within 120 days of receiving a completed application to ensure timely provider credentialing.
URAC Credentialing Standards require organizations to complete the initial credentialing process within 120 days of receiving a completed credentialing application. This standard ensures that providers are not left in limbo and that organizations maintain efficient processes. Delays beyond this threshold may require explanation and corrective action plans.
Question 3: Which NCQA credentialing standard addresses the delegation of credentialing activities to another organization?
- CR 1
- CR 7
- CR 9 (Correct answer)
- CR 12
Correct answer: CR 9
NCQA CR 9 specifically addresses delegation of credentialing and recredentialing activities, outlining requirements for oversight of delegated functions.
NCQA CR 9 (Delegation of Credentialing and Recredentialing) establishes requirements for organizations that delegate credentialing activities to another entity. This includes requirements for a signed delegation agreement, pre-delegation audit, ongoing oversight, and annual evaluation of delegated activities. The delegating organization retains ultimate accountability for compliance.
Question 4: DNV GL Healthcare integrates which management system standard into its hospital accreditation program?
- ISO 9001 (Correct answer)
- ISO 14001
- ISO 45001
- ISO 27001
Correct answer: ISO 9001
DNV GL Healthcare integrates ISO 9001 quality management system requirements into its NIAHO accreditation program, distinguishing it from other accreditation bodies.
DNV GL Healthcare's National Integrated Accreditation for Healthcare Organizations (NIAHO) program uniquely integrates ISO 9001 quality management system requirements with Medicare Conditions of Participation. This integration requires hospitals to implement a continuous quality improvement framework and document management system that goes beyond traditional accreditation requirements.
Question 5: Under NCQA standards, which of the following is considered an 'adverse action' that must be reported to the NPDB?
- Granting privileges with conditions
- Voluntary surrender of privileges while under investigation (Correct answer)
- Temporary suspension pending investigation lasting less than 30 days
- Denial of initial application for administrative reasons
Correct answer: Voluntary surrender of privileges while under investigation
Voluntary surrender of privileges while under investigation or to avoid investigation is a reportable adverse action to the NPDB under NCQA credentialing standards and federal law.
Under HCQIA and NCQA standards, voluntary surrender of clinical privileges while under investigation, or in return for not conducting an investigation, must be reported to the NPDB. This prevents practitioners from avoiding adverse action reports by resigning before a formal action is taken. NCQA requires credentialing specialists to verify NPDB reports and understand what constitutes a reportable action.
Question 6: Which accreditation body requires a 'deemed status' survey that satisfies Medicare Conditions of Participation?
- NCQA only
- URAC only
- TJC and DNV GL Healthcare (Correct answer)
- NCQA and URAC
Correct answer: TJC and DNV GL Healthcare
Both The Joint Commission and DNV GL Healthcare have CMS-approved deemed status authority, meaning their accreditation surveys satisfy Medicare Conditions of Participation requirements.
The Centers for Medicare and Medicaid Services (CMS) grants 'deemed status' authority to accreditation organizations whose standards are equivalent to or exceed Medicare Conditions of Participation. The Joint Commission and DNV GL Healthcare both hold this authority for hospitals. This means hospitals accredited by these organizations are 'deemed' to meet Medicare requirements without a separate CMS survey, though CMS retains the right to conduct validation surveys.
CPCS CPCS - Certified Provider Credentialing Specialist Accreditation Standards and Compliance Questions and Answers 2
Which accreditation organization requires a credentialing committee to include at least one physician member when making privileging recommendations?